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MEDICINE SHOPPE RIDGWAY
CAH141324-00 Ferrell Hospital Community Foundation dba Ferrell Hospital
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Covered Entity Details
Entity Name
Ferrell Hospital Community Foundation dba Ferrell Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141324-00
Entity Address
1201 Pine Street
Eldorado, IL 62930
Medicare Provider Number
141324
Participating Start Date
4/1/2012
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
MEDICINE SHOPPE RIDGWAY
Pharmacy Address
PRN PHARMACIES LTD
101 E MAIN ST
RIDGWAY, IL 62979
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
5/13/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angela Marie Craig, Controller
(618) 273-3361 Ext: 157
Contract Pharmacy Representative
Medicine Shoppe
Brad Ledbetter, Vice President
(618) 252-5349
Signed By Date
4/15/2020
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